UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
HEALTH and WELFARE FUND

How to Use This Booklet

We have designed this booklet to help you and your family understand your benefits package under the UFCW Local 1776 and Participating Employers Health and Welfare Fund. This booklet refers to your benefits package as the "Plan."

On the next few pages, you will find a "Benefits at a Glance" chart which will give you a quick overview of the benefits available to you and your eligible dependents under the Plan. In other sections, you will find details about your eligibility, what is covered, how to file or appeal a claim, whom to call when you have questions, and other important information.

If you still have questions about your benefits after you read this booklet, contact the Fund office at (610) 941-9400 or 1-800-458-8618

Specifically, the Plan provides these benefits:

Medical Coverage

Personal Choice Plan A

Keystone Point of Service Program (optional; for participants in the Flexible Benefits Plan)

Dual Income Option (optional; for participants in the Flexible Benefits Plan)

Medical Flexible Spending Account (for participants in the Flexible Benefits Plan)

Mental, Nervous, Drug and Alcohol

Dental

Prescription Drug

Prescription Incentive Program

Vision

Disability

Life Insurance

Accidental Death & Dismemberment

Child Care

Educational Benefit Program

Physical Well Being Program

Certain benefits, including the Keystone Point of Service Program, the Dual Income Option and the Medical Flexible Spending Account, are available to Fund participants who are also eligible to participate in the UFCW Local 1776 and Participating Employers Flexible Benefits Plan. You should refer to the Flexible Benefits Plan Summary for more details and to determine whether you are eligible to participate in the Flexible Benefits Plan.

Legal services are provided under the UFCW Local 1776 and Participating Employers Legal Trust Fund, which is a separate fund. You should refer to the Summary Plan Description for the Legal Trust Fund for an explanation of those benefits.

Some of these benefits are available only to you, while others are also provided for your dependents. To understand what you and your dependents are entitled to under the Plan, please read this booklet carefully and share it with your family. Then keep it with your important papers, so you can refer to it whenever you use your Plan benefits.

We have written this booklet in plain, everyday language to be sure you understand your rights under the Plan. If you still have questions about your benefits after you read this booklet, contact the Fund office at (610) 941-9400 or 1-800-458-8618.You can also write to the Fund Administrator at the address in the section titled "Administrative Information."

This summary plan description is just that - a summary of your benefits. Therefore, we do not discuss all provisions of the Plan here. Some of the benefits summarized herein are provided pursuant to policies of insurance or other underlying documents. In that case, the applicable policy of insurance or other underlying documents are incorporated by reference as if fully set forth in this booklet. If there are any discrepancies, the policy of insurance or other underlying documents prevail. If you wish to review the policy of insurance or other underlying documents, please contact the Fund office.